Therapists explain common causes of anorexia nervosa
Updated 17 March 2015
by Sarah Graham
Tuesday 24 February 2015645 1905
Anorexia nervosa is an eating disorder characterised by dramatic weight loss and a preoccupation with body image, shape and size. Like many mental health conditions, it is usually caused by a number of contributing factors, as Registered Counsellor Styliani Stathi explains: "It is difficult to attribute such a complex disorder as anorexia nervosa to a single cause – rather, it is always a combination of personal and environmental factors and experiences that lead to its onset." We asked RSCPP therapists to explain some of these interlinking causes of anorexia.
Societal pressures and difficult life events
Anorexia occurs in the context of a predisposition, affected by physical, genetic and personality factors, combined with societal pressures to value specific body sizes and shapes. It is precipitated by everyday life events, for example a pet dying, parental conflict, difficulties in relationships, academic pressures or many other issues. The area that is most significant is the perpetuating factors, as these are what ensures the anorexia develops a hold on you.
One of the most consistent findings in anorexia sufferers, from a personality perspective, is the characteristic of perfectionism - you may have a rigid, rather uncompromising, and often exclusive focus on achieving the particularly high goals that you set for yourself, and on being and appearing as 'the best' at what you do. Thus, your body turns into another achievement and has to be formed into the 'perfect version' of itself, according to your perception. Perfectionism is characterised by a very 'black-and-white' way of thinking, which is reflected in the way you may classify different food types into 'good' and 'bad', and completely eliminate the bad ones from your diet, as well as in your unyielding intolerance of signs of body flesh that you perceive as fat. Underneath this burning desire to be 'perfect', there is the underlying core belief that you are 'never enough', the origins of which may be found in childhood experiences and messages within your family. It is no coincidence that anorexia typically tends to affect over-achieving, highly successful girls and women, coming from families who greatly value and encourage these traits.
Feelings of shame
Anorexia is linked with a sense of shame; a desire not to take up any space in the world; the idea that, if you can make yourself as tiny as possible, perhaps you can avoid being seen. Think for a moment of the contrast between a healthy, happy child, and a child who fears that he or she may not be approved of, admired, loved or wanted for some reason. The happy child wants attention and will often say, "look at me!" The fearful, shamed child avoids it, or attracts negative attention. The problem is that young children find it difficult to distinguish between feeling something and doing it, so an angry child may feel as though he or she has actually done something angry or bad, leading to a sense of fear and shame. If you experienced this, the unbearable feelings probably got hidden away from your consciousness, but they can leave you with a sense of being bad, or feeling ashamed in some way. You may have no idea exactly what caused the feeling, but it may be enough to make you want to shrink away from the world, and from intimate contact with other people. Although the underlying causes of anorexia are complex and variable, one of the common factors is usually this vague sense of not being good or all right, which you may try to control and manage by a strict and brutal bodily regime of deprivation.
Family members and peers
As with any addictive behaviour, disordered eating tends to have rooted links with members of the family. If any issue with food was established in childhood, then this would be the outlet you're most likely to be attracted to. Mums/dads may use food to both soothe and punish, which is confusing; a relative may make unhelpful remarks about fat people, or be critical of you. Food's familiarity, and your associations with it, will be both comforting and shameful, and thus begins the secretive cycle of destructive thinking and controlling eating behaviour. This behaviour can also be reinforced at school when children can be cruel and unforgiving in their taunts. If you already have issues of low self-esteem then it would be very easy to choose control of food to regulate your emotions. The result is living in fear, and an extortionate amount of each day being given to obsessing about food, weight, body image, leaving you feeling worried and alone.
You can find out more about symptoms and causes of Anorexia Nervosa
, including how to find a therapist. If this route is not appropriate for you, your GP can assess you and direct you towards support.